Peri-operative care for patients undergoing lymphaticovenular anastomosis: A systematic review

被引:14
|
作者
Winters, Harm [1 ]
Tielemans, Hanneke J. P. [1 ]
Sprangers, Philippe N. [1 ]
Ulrich, Dietmar J. O. [1 ]
机构
[1] Radboud Univ Nijmegen Med Ctr, Dept Plast & Reconstruct Surg, POB 9101, NL-6500 HB Nijmegen, Netherlands
来源
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY | 2017年 / 70卷 / 02期
关键词
Lymphaticovenular anastomosis; Lymphedema surgery; Peri-operative care; Systematic review; EXTREMITY LYMPHEDEMA; FLUORESCENCE MICROLYMPHOGRAPHY; PERIPHERAL LYMPHEDEMA; VENOUS ANASTOMOSIS; RISK-FACTORS; LYMPHOGRAPHY; PROSTAGLANDIN-E1; IMPLANTATION; PRESSURE; BYPASS;
D O I
10.1016/j.bjps.2016.11.016
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Lymphaticovenular anastomosis ( LVA) is a supermicrosurgical procedure that involves the anastomosis of a functional lymphatic channel to a venule. Although perioperative care might be an important contributor to the success of this technique, evidence about optimal peri-operative care seems limited. This review aims to summarize the perioperative methods used by authors reporting on LVA. Methods: A systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peri-operative care used by authors was summarized and listed in a pre-defined form. Studies were also graded on quality of evidence by the GRADE system and a lymphedema surgery-specific system. Results: In total, 22 studies were identified describing peri-operative measures. Although most authors were sparse in their description of peri-operative management, most recommended initiation of conventional compression therapy at 1-4 weeks after surgery. Prophylactic antibiotics, elevation of the affected limb, bandaging, low-molecular-weight heparin, prostaglandin E1, and manual pressure therapy were also described. The quality of evidence of the included studies was low on average. Conclusion: Although supermicrosurgical LVAs are gaining in popularity, there are no highquality prospective trials evaluating these new techniques and the description of perioperative management is scarce. Of the available studies, a peri-operative management consisting of prophylactic antibiotics, elevation of the affected limb during night and hospital stay, and compression therapy 4 weeks post-surgery for 6 months seems to be preferred. Future studies should describe a detailed peri-operative protocol to allow for a better comparison between study results and to determine optimal peri-operative recommendations. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:178 / 188
页数:11
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